Diabetic ketoacidosis amongst patients with COVID-19: A retrospective chart review of 220 patients in Pakistan

Asim Muhammad; Muhammad Hakim; Saima Afaq; Farhad Ali Khattak; Najmush Shakireen; Muhammad Jawad; Rabia Saeed; Zia Ul Haq

doi:10.1002/edm2.331

Diabetic ketoacidosis amongst patients with COVID-19: A retrospective chart review of 220 patients in Pakistan

Asim Muhammad, Muhammad Hakim, Saima Afaq, Farhad Ali Khattak, Najmush Shakireen, Muhammad Jawad, Rabia Saeed, Zia Ul Haq

Health Sciences

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVES: To determine the frequency of diabetes mellitus and diabetic ketoacidosis and associated factors in COVID-19-positive patients.

BACKGROUND: High mortality amongst SARS-Cov2 patients may be attributed to diabetes and diabetic ketoacidosis.

METHODS: A total of 220 COVID-19 positive patients, hospitalized in North West General Hospital & Research Center, Peshawar, KP, Pakistan, from April to September 2020, were analysed using STATA 14. Patients with positive PCR were labelled as COVID-19 positive and were included in the study. Patients with a clinical picture of COVID-19 and negative PCR were excluded from the study. Those having ketonemia >0.6 and random blood glucose level >250mg/dl, while HCO3 (bicarbonate) ≤18, were labelled as diabetic ketoacidosis. The statistical significance level was set at p < .05.

RESULTS: A total of 220 COVID-19 patients were admitted; 166 (75.4%) were male and 54 (24.5%) were female. The mean age in years of the patients was 55.95 (SD13.9). About 57.7% of patients had diabetes mellitus, and 15 (6.8%) patients developed diabetic ketoacidosis. Amongst those with DKA, 5 patients died during hospital admission. The use of steroids was significantly higher (p < .001) in the DKA group compared with non-DKA patients. Hypertension (103,46.8%) and fever (170,77.3%) were the most reported comorbidity and symptom respectively.

CONCLUSION: The proportion of diabetes mellitus is high in patients with COVID-19. Diabetic ketoacidosis is a frequent complication in this group associated with in-hospital mortality. Steroid administration for COVID-19 should be balanced with strict glycemic control to prevent diabetic ketoacidosis and increase hospital survival.

Original language	English
Pages (from-to)	e00331
Journal	Endocrinology, diabetes & metabolism
Volume	5
Issue number	3
DOIs	https://doi.org/10.1002/edm2.331
Publication status	Published - 11 May 2022

Bibliographical note

Keywords

Bicarbonates
COVID-19/complications
Diabetes Mellitus/epidemiology
Diabetic Ketoacidosis/epidemiology
Female
Humans
Male
Pakistan/epidemiology
RNA, Viral
Retrospective Studies
SARS-CoV-2

Access to Document

10.1002/edm2.331Licence: CC BY

Cite this

@article{151e4e17d71146249cf86b3659e521ff,

title = "Diabetic ketoacidosis amongst patients with COVID-19: A retrospective chart review of 220 patients in Pakistan",

abstract = "OBJECTIVES: To determine the frequency of diabetes mellitus and diabetic ketoacidosis and associated factors in COVID-19-positive patients.BACKGROUND: High mortality amongst SARS-Cov2 patients may be attributed to diabetes and diabetic ketoacidosis.METHODS: A total of 220 COVID-19 positive patients, hospitalized in North West General Hospital & Research Center, Peshawar, KP, Pakistan, from April to September 2020, were analysed using STATA 14. Patients with positive PCR were labelled as COVID-19 positive and were included in the study. Patients with a clinical picture of COVID-19 and negative PCR were excluded from the study. Those having ketonemia >0.6 and random blood glucose level >250mg/dl, while HCO3 (bicarbonate) ≤18, were labelled as diabetic ketoacidosis. The statistical significance level was set at p < .05.RESULTS: A total of 220 COVID-19 patients were admitted; 166 (75.4%) were male and 54 (24.5%) were female. The mean age in years of the patients was 55.95 (SD13.9). About 57.7% of patients had diabetes mellitus, and 15 (6.8%) patients developed diabetic ketoacidosis. Amongst those with DKA, 5 patients died during hospital admission. The use of steroids was significantly higher (p < .001) in the DKA group compared with non-DKA patients. Hypertension (103,46.8%) and fever (170,77.3%) were the most reported comorbidity and symptom respectively.CONCLUSION: The proportion of diabetes mellitus is high in patients with COVID-19. Diabetic ketoacidosis is a frequent complication in this group associated with in-hospital mortality. Steroid administration for COVID-19 should be balanced with strict glycemic control to prevent diabetic ketoacidosis and increase hospital survival.",

keywords = "Bicarbonates, COVID-19/complications, Diabetes Mellitus/epidemiology, Diabetic Ketoacidosis/epidemiology, Female, Humans, Male, Pakistan/epidemiology, RNA, Viral, Retrospective Studies, SARS-CoV-2",

author = "Asim Muhammad and Muhammad Hakim and Saima Afaq and Khattak, {Farhad Ali} and Najmush Shakireen and Muhammad Jawad and Rabia Saeed and Haq, {Zia Ul}",

note = "{\textcopyright} 2022 The Authors. Endocrinology, Diabetes & Metabolism published by John Wiley & Sons Ltd.",

year = "2022",

month = may,

day = "11",

doi = "10.1002/edm2.331",

language = "English",

volume = "5",

pages = "e00331",

journal = "Endocrinology, diabetes & metabolism",

issn = "2398-9238",

publisher = "Wiley-Blackwell Publishing Ltd",

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}

TY - JOUR

T1 - Diabetic ketoacidosis amongst patients with COVID-19

T2 - A retrospective chart review of 220 patients in Pakistan

AU - Muhammad, Asim

AU - Hakim, Muhammad

AU - Afaq, Saima

AU - Khattak, Farhad Ali

AU - Shakireen, Najmush

AU - Jawad, Muhammad

AU - Saeed, Rabia

AU - Haq, Zia Ul

PY - 2022/5/11

Y1 - 2022/5/11

N2 - OBJECTIVES: To determine the frequency of diabetes mellitus and diabetic ketoacidosis and associated factors in COVID-19-positive patients.BACKGROUND: High mortality amongst SARS-Cov2 patients may be attributed to diabetes and diabetic ketoacidosis.METHODS: A total of 220 COVID-19 positive patients, hospitalized in North West General Hospital & Research Center, Peshawar, KP, Pakistan, from April to September 2020, were analysed using STATA 14. Patients with positive PCR were labelled as COVID-19 positive and were included in the study. Patients with a clinical picture of COVID-19 and negative PCR were excluded from the study. Those having ketonemia >0.6 and random blood glucose level >250mg/dl, while HCO3 (bicarbonate) ≤18, were labelled as diabetic ketoacidosis. The statistical significance level was set at p < .05.RESULTS: A total of 220 COVID-19 patients were admitted; 166 (75.4%) were male and 54 (24.5%) were female. The mean age in years of the patients was 55.95 (SD13.9). About 57.7% of patients had diabetes mellitus, and 15 (6.8%) patients developed diabetic ketoacidosis. Amongst those with DKA, 5 patients died during hospital admission. The use of steroids was significantly higher (p < .001) in the DKA group compared with non-DKA patients. Hypertension (103,46.8%) and fever (170,77.3%) were the most reported comorbidity and symptom respectively.CONCLUSION: The proportion of diabetes mellitus is high in patients with COVID-19. Diabetic ketoacidosis is a frequent complication in this group associated with in-hospital mortality. Steroid administration for COVID-19 should be balanced with strict glycemic control to prevent diabetic ketoacidosis and increase hospital survival.

AB - OBJECTIVES: To determine the frequency of diabetes mellitus and diabetic ketoacidosis and associated factors in COVID-19-positive patients.BACKGROUND: High mortality amongst SARS-Cov2 patients may be attributed to diabetes and diabetic ketoacidosis.METHODS: A total of 220 COVID-19 positive patients, hospitalized in North West General Hospital & Research Center, Peshawar, KP, Pakistan, from April to September 2020, were analysed using STATA 14. Patients with positive PCR were labelled as COVID-19 positive and were included in the study. Patients with a clinical picture of COVID-19 and negative PCR were excluded from the study. Those having ketonemia >0.6 and random blood glucose level >250mg/dl, while HCO3 (bicarbonate) ≤18, were labelled as diabetic ketoacidosis. The statistical significance level was set at p < .05.RESULTS: A total of 220 COVID-19 patients were admitted; 166 (75.4%) were male and 54 (24.5%) were female. The mean age in years of the patients was 55.95 (SD13.9). About 57.7% of patients had diabetes mellitus, and 15 (6.8%) patients developed diabetic ketoacidosis. Amongst those with DKA, 5 patients died during hospital admission. The use of steroids was significantly higher (p < .001) in the DKA group compared with non-DKA patients. Hypertension (103,46.8%) and fever (170,77.3%) were the most reported comorbidity and symptom respectively.CONCLUSION: The proportion of diabetes mellitus is high in patients with COVID-19. Diabetic ketoacidosis is a frequent complication in this group associated with in-hospital mortality. Steroid administration for COVID-19 should be balanced with strict glycemic control to prevent diabetic ketoacidosis and increase hospital survival.

KW - Bicarbonates

KW - COVID-19/complications

KW - Diabetes Mellitus/epidemiology

KW - Diabetic Ketoacidosis/epidemiology

KW - Female

KW - Humans

KW - Male

KW - Pakistan/epidemiology

KW - RNA, Viral

KW - Retrospective Studies

KW - SARS-CoV-2

U2 - 10.1002/edm2.331

DO - 10.1002/edm2.331

M3 - Article

C2 - 35212184

SN - 2398-9238

VL - 5

SP - e00331

JO - Endocrinology, diabetes & metabolism

JF - Endocrinology, diabetes & metabolism

IS - 3

ER -